Course of scar quality of donor sites following split skin graft harvesting: Comparison between patients and observers

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Abstract
There exists little to no data on the development of donor‐site scars that remain after split skin graft harvesting. The objectives of this study were to 1) examine changes in characteristics of donor‐site scar quality over time and 2) assess the agreement between patient‐reported and observer‐reported donor‐site scar quality in a burn population. A prospective cohort study was conducted including patients that underwent split skin grafting for their burn injury. Patients and observers completed the Patient and Observer Scar Assessment Scale (POSAS) for the first harvested donor‐site at 3 an 12 months post‐surgery. This study included 80 patients with a median age of 34 years. At 3 months post‐surgery the patients scored the POSAS items itch and color as most deviant from normal skin, both improved between 3 and 12 months (3.1 vs 1.5 and 5.0 vs 3.5, respectively [P < 0.001]). Other scar characteristics did not show significant change over time. The patients’ overall opinion score improved from 3.9 to 3.2 (P < 0.001). Observers rated the items vascularization and pigmentation most severe, only vascularization improved significantly between both time points. Their overall opinion score decreased from 2.7 to 2.3 (P < 0.001). The inter‐observer agreement between patients and observers was considered poor (ICC < 0.4) at both time points. Results of current study indicate that observers underestimate the impact of donor‐site scars. This has to be kept in mind whilst guiding therapy and expectations. LEVEL OF EVIDENCE: II, prospective cohort study.

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